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Griffiths M, Hatabah D, Sullivan P, Mantus G, Sanchez T, Zlotorzynska M, Heilman S, Camacho-Gonzalez A, Leake D, Korman R, Le M, Suthara M, Wrammert J, Vos MB, Morris CR. Incidence of SARS-CoV-2 Seropositivity in Pediatric Healthcare Workers Prior to Widespread Vaccination: A Five-month Longitudinal Cohort Study. Int J Infect Dis 2024:107064. [PMID: 38641316 DOI: 10.1016/j.ijid.2024.107064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Revised: 03/28/2024] [Accepted: 04/16/2024] [Indexed: 04/21/2024] Open
Abstract
OBJECTIVES Determine SARS-CoV-2 IgG antibody incidence over time in unvaccinated pediatric healthcare workers (pHCWs). DESIGN Prospective longitudinal cohort of unvaccinated pHCWs measuring incidence of new infection after initial prevalence was established at 4.1% with seropositive predominance in emergency department (ED)-based pHCWs. Serum samples were collected at follow-up visits to detect new SARS-CoV-2 seropositivity. Univariate analysis was performed to estimate different incidence rates between participant demographics, job, employment location and community risk factors. Anxiety levels about COVID-19 were collected. SARS-CoV-2 antibody decay post-infection, and neutralization antibodies were evaluated. Log-linear Poisson regression models were used to estimate incidence. RESULTS Of 642 initially enrolled, 390 pHCWs presented for at least one follow-up serology test after baseline analysis. Incidence of SARS-CoV-2 seropositivity was 8.2%. The seropositive cohort, like the negative one consisted mainly of females in non-ED settings and non-physician roles. There were no statistically significant differences in incidence across variables. Seropositive participants dropped antibody titers by 50% at 3 months. Neutralization antibodies correlated to SARs-CoV-2 binding antibodies (r=0.43,p<0.0001). CONCLUSION Incidence of seropositivity was 8.2%. Although seropositivity was higher among ED staff during early stages of the pandemic, this difference declined over time, likely due to universal adoption of personal protective equipment (PPE).
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Affiliation(s)
- Mark Griffiths
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, United States; Children's Healthcare of Atlanta, Atlanta, GA, United States
| | - Dunia Hatabah
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, United States
| | - Patrick Sullivan
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, United States
| | - Grace Mantus
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, United States
| | - Travis Sanchez
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, United States
| | - Maria Zlotorzynska
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, United States
| | - Stacy Heilman
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, United States
| | - Andres Camacho-Gonzalez
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, United States; Children's Healthcare of Atlanta, Atlanta, GA, United States; Center for Childhood Infections and Vaccines of Children's Healthcare of Atlanta and Emory University, Atlanta, GA, United States
| | - Deborah Leake
- Children's Healthcare of Atlanta, Atlanta, GA, United States
| | - Rawan Korman
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, United States
| | - Mimi Le
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, United States; Center for Clinical and Translational Research, of Children's Healthcare of Atlanta and Emory University, Atlanta, GA, United States
| | - Mehul Suthara
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, United States; Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, United States
| | - Jens Wrammert
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, United States; Center for Childhood Infections and Vaccines of Children's Healthcare of Atlanta and Emory University, Atlanta, GA, United States
| | - Miriam B Vos
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, United States; Children's Healthcare of Atlanta, Atlanta, GA, United States; Center for Clinical and Translational Research, of Children's Healthcare of Atlanta and Emory University, Atlanta, GA, United States
| | - Claudia R Morris
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, United States; Children's Healthcare of Atlanta, Atlanta, GA, United States; Center for Clinical and Translational Research, of Children's Healthcare of Atlanta and Emory University, Atlanta, GA, United States.
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Lowenthal ED, Chapman J, Ohrenschall R, Calabrese K, Baltrusaitis K, Heckman B, Yin DE, Agwu AL, Harrington C, Van Solingen-Ristea RM, McCoig CC, Adeyeye A, Kneebone J, Chounta V, Smith-Anderson C, Camacho-Gonzalez A, D'Angelo J, Bearden A, Crauwels H, Huang J, Buisson S, Milligan R, Ward S, Bolton-Moore C, Gaur AH. Acceptability and tolerability of long-acting injectable cabotegravir or rilpivirine in the first cohort of virologically suppressed adolescents living with HIV (IMPAACT 2017/MOCHA): a secondary analysis of a phase 1/2, multicentre, open-label, non-comparative dose-finding study. Lancet HIV 2024; 11:e222-e232. [PMID: 38538161 PMCID: PMC11061207 DOI: 10.1016/s2352-3018(23)00301-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Revised: 10/06/2023] [Accepted: 11/13/2023] [Indexed: 04/16/2024]
Abstract
BACKGROUND Long-acting injectable cabotegravir and rilpivirine have demonstrated safety, acceptability, and efficacy in adults living with HIV-1. The IMPAACT 2017 study (MOCHA study) was the first to use these injectable formulations in adolescents (aged 12-17 years) living with HIV-1. Herein, we report acceptability and tolerability outcomes in cohort 1 of the study. METHODS In this a secondary analysis of a phase 1/2, multicentre, open-label, non-comparative dose-finding study, with continuation of pre-study oral combination antiretroviral treatment (ART), 55 adolescents living with HIV-1 were enrolled to receive sequential doses of either long-acting cabotegravir or rilpivirine and 52 received at least two injections. Participants had a body weight greater than 35 kg and BMI less than 31·5 kg/m2 and had been on stable ART for at least 90 consecutive days with an HIV-1 viral load of less than 50 copies per mL at a participating IMPAACT study site. Participants had to be willing to continue their pre-study ART during cohort 1. The primary objectives of the study were to confirm doses for oral and injectable cabotegravir and for injectable rilpivirine in adolescents living with HIV. This analysis of participant-reported outcomes included a face scale assessment of pain at each injection and a Pediatric Quality of Life Inventory (PedsQL) at baseline and week 16 for participants in the USA, South Africa, Botswana, and Thailand. A subset of 11 adolescents and 11 parents or caregivers in the USA underwent in-depth interviews after receipt of one or two injections. This trial is registered at ClinicalTrials.gov, NCT03497676. FINDINGS Between March 19, 2019, and Nov 25, 2021, 55 participants were enrolled into cohort 1. Using the six-point face scale, 43 (83%) of participants at week 4 and 38 (73%) at week 8 reported that the injection caused "no hurt" or "hurts little bit", while only a single (2%) participant for each week rated the pain as one of the two highest pain levels. Quality of life was not diminished by the addition of one injectable antiretroviral. In-depth interviews revealed that parents and caregivers in the USA frequently had more hesitancy than adolescents about use of long-acting formulations, but parental acceptance was higher after their children received injections. INTERPRETATION High acceptability and tolerability of long-acting cabotegravir or rilpivirine injections suggests that these are likely to be favoured treatment options for some adolescents living with HIV. FUNDING National Institutes of Health and ViiV Healthcare.
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Affiliation(s)
- Elizabeth D Lowenthal
- The Children's Hospital of Philadelphia, Division of General Pediatrics and Global Health Center, Philadelphia, PA, USA; University of Pennsylvania Perelman School of Medicine, Departments of Pediatrics and Biostatistics, Epidemiology and Informatics, Philadelphia, PA, USA.
| | - Jennifer Chapman
- The Children's Hospital of Philadelphia, Division of General Pediatrics and Global Health Center, Philadelphia, PA, USA
| | | | | | - Kristin Baltrusaitis
- Center for Biostatistics in AIDS Research, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | | | - Dwight E Yin
- National Institute of Allergy and Infectious Diseases (NIAID) Division of AIDS, National Institutes of Health (NIH), Rockville, MD, USA
| | - Allison L Agwu
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | | | | | | | - Adeola Adeyeye
- National Institute of Allergy and Infectious Diseases (NIAID) Division of AIDS, National Institutes of Health (NIH), Rockville, MD, USA
| | | | | | | | | | - Jessica D'Angelo
- Northwestern University and Lurie Children's Hospital of Chicago, Chicago, IL, USA
| | - Allison Bearden
- Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA
| | | | - Jenny Huang
- ViiV Healthcare, Research Triangle Park, NC, USA
| | | | | | - Shawn Ward
- Frontier Science Foundation, Amherst, NY, USA
| | - Carolyn Bolton-Moore
- Centre for Infectious Disease Research in Zambia/University of Alabama Birmingham, Lusaka, Zambia
| | - Aditya H Gaur
- St Jude Children's Research Hospital, Memphis, TN, USA
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Gaur AH, Capparelli EV, Calabrese K, Baltrusaitis K, Marzinke MA, McCoig C, Van Solingen-Ristea RM, Mathiba SR, Adeyeye A, Moye JH, Heckman B, Lowenthal ED, Ward S, Milligan R, Samson P, Best BM, Harrington CM, Ford SL, Huang J, Crauwels H, Vandermeulen K, Agwu AL, Smith-Anderson C, Camacho-Gonzalez A, Ounchanum P, Kneebone JL, Townley E, Bolton Moore C. Safety and pharmacokinetics of oral and long-acting injectable cabotegravir or long-acting injectable rilpivirine in virologically suppressed adolescents with HIV (IMPAACT 2017/MOCHA): a phase 1/2, multicentre, open-label, non-comparative, dose-finding study. Lancet HIV 2024; 11:e211-e221. [PMID: 38538160 DOI: 10.1016/s2352-3018(23)00300-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Revised: 10/06/2023] [Accepted: 11/13/2023] [Indexed: 04/07/2024]
Abstract
BACKGROUND Combined intramuscular long-acting cabotegravir and long-acting rilpivirine constitute the first long-acting combination antiretroviral therapy (ART) regimen approved for adults with HIV. The goal of the IMPAACT 2017 study (MOCHA [More Options for Children and Adolescents]) was to assess the safety and pharmacokinetics of these drugs in adolescents. METHODS In this phase 1/2, multicentre, open-label, non-comparative, dose-finding study, virologically suppressed adolescents (aged 12-17 years; weight ≥35 kg; BMI ≤31·5 kg/m2) with HIV-1 on daily oral ART were enrolled at 15 centres in four countries (Botswana, South Africa, Thailand, and the USA). After 4-6 weeks of oral cabotegravir (cohort 1C) or rilpivirine (cohort 1R), participants received intramuscular long-acting cabotegravir or long-acting rilpivirine every 4 weeks or 8 weeks per the adult dosing regimens, while continuing pre-study ART. The primary outcomes were assessments of safety measures, including all adverse events, until week 4 for oral cabotegravir and until week 16 for long-acting cabotegravir and long-acting rilpivirine, and pharmacokinetic measures, including the area under the plasma concentration versus time curve during the dosing interval (AUC0-tau) and drug concentrations, at week 2 for oral dosing of cabotegravir and at week 16 for intramuscular dosing of cabotegravir and rilpivirine. Enrolment into cohort 1C or cohort 1R was based on the participant's pre-study ART, meaning that masking was not done. For pharmacokinetic analyses, blood samples were drawn at weeks 2-4 after oral dosing and weeks 4-16 after intramuscular dosing. Safety outcome measures were summarised using frequencies, percentages, and exact 95% CIs; pharmacokinetic parameters were summarised using descriptive statistics. This trial is registered at ClinicalTrials.gov, NCT03497676, and is closed to enrolment. FINDINGS Between March 19, 2019, and Nov 25, 2021, 55 participants were enrolled: 30 in cohort 1C and 25 in cohort 1R. At week 16, 28 (97%, 95% CI 82-100) of the 29 dose-evaluable participants in cohort 1C and 21 (91%; 72-99) of the 23 dose-evaluable participants in cohort 1R had reported at least one adverse event, with the most common being injection-site pain (nine [31%] in cohort 1C; nine [39%] in cohort 1R; none were severe). One (4%, 95% CI 0-22) participant in cohort 1R had an adverse event of grade 3 or higher, leading to treatment discontinuation, which was defined as acute rilpivirine-related allergic reaction (self-limiting generalised urticaria) after the first oral dose. No deaths or life-threatening events occurred. In cohort 1C, the week 2 median cabotegravir AUC0-tau was 148·5 (range 37·2-433·1) μg·h/mL. The week 16 median concentrations for the every-4-weeks and every-8-weeks dosing was 3·11 μg/mL (range 1·22-6·19) and 1·15 μg/mL (<0·025-5·29) for cabotegravir and 52·9 ng/mL (31·9-148·0) and 39·1 ng/mL (27·2-81·3) for rilpivirine, respectively. These concentrations were similar to those in adults. INTERPRETATION Study data support using long-acting cabotegravir or long-acting rilpivirine, given every 4 weeks or 8 weeks, per the adult dosing regimens, in virologically suppressed adolescents aged 12 years and older and weighing at least 35 kg. FUNDING The National Institutes of Health and ViiV Healthcare.
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Affiliation(s)
- Aditya H Gaur
- St Jude Children's Research Hospital, Memphis, TN, USA.
| | | | | | - Kristin Baltrusaitis
- Center for Biostatistics in AIDS Research, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Mark A Marzinke
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | | | | | | | - Adeola Adeyeye
- National Institute of Allergy and Infectious Diseases, National Institutes of Health, Rockville, MD, USA
| | - John H Moye
- Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), Bethesda, MD, USA
| | | | - Elizabeth D Lowenthal
- University of Pennsylvania Perelman School of Medicine, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Shawn Ward
- Frontier Science Foundation, Boston, MA, USA
| | | | | | | | | | | | | | | | | | - Allison L Agwu
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | | | | | | | | | - Ellen Townley
- National Institute of Allergy and Infectious Diseases, National Institutes of Health, Rockville, MD, USA
| | - Carolyn Bolton Moore
- Centre for Infectious Disease Research in Zambia, Lusaka, Zambia; University of Alabama, Birmingham, AL, USA
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Labudde EJ, Gillespie S, Wood A, Middlebrooks L, Gooding HC, Morris CR, Camacho-Gonzalez A. HIV in youth prevention in the emergency department initiative: A survey of pediatric emergency medicine providers. Am J Emerg Med 2023; 72:164-169. [PMID: 37536088 DOI: 10.1016/j.ajem.2023.07.041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 06/28/2023] [Accepted: 07/22/2023] [Indexed: 08/05/2023] Open
Abstract
BACKGROUND The incidence of HIV among adolescents remains high, and adolescents are known to participate in sexual behaviors that increase their risk for HIV, such as unprotected sex and sex with multiple partners. HIV pre-exposure prophylaxis (PrEP) has been shown to be effective at preventing HIV when taken daily and is approved by the FDA for use in adolescents. Efforts to screen patients in adult emergency departments and connect them with PrEP services have been validated. We surveyed pediatric emergency medicine (PEM) providers to determine their knowledge of PrEP, prescribing practices, willingness to prescribe, and barriers to a screening protocol in the pediatric emergency department (PED). METHODS We administered a survey to a multidisciplinary group of PEM providers to measure knowledge, use, willingness, and implementation barriers to PrEP as well as elements needed for a successful referral system. RESULTS A total of 87 responses were included for analysis. While 79.1% of all providers had heard of PrEP, only 14.8% of prescribing providers had ever discussed PrEP with a patient, and none had ever prescribed PrEP. Overall, 76.3% of all providers were knowledgeable about PrEP based on answers to true/false questions, with prescribing providers significantly more likely to be knowledgeable compared to nurses (p = 0.005). Knowledgeable providers had higher willingness scores to refer for PrEP compared to providers who were not knowledgeable. Ninety-two percent of providers felt a PrEP referral process from the PED would be feasible. Creation of an eligibility algorithm and educational materials were the most common efforts providers preferred to make them more likely to refer for PrEP. The most notable barriers perceived by providers included patient noncompliance with therapy (20.9%), acceptance of PrEP discussion among patients and parents (19.8%), and cost of therapy (15.1%). CONCLUSION PEM providers are knowledgeable about PrEP but have little experience with discussing or prescribing PrEP. Their willingness to refer for PrEP and anticipated feasibility of a PrEP referral system is encouraging. These results support the need for future educational efforts among PEM providers and creation of referral systems for PrEP services from the PED.
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Affiliation(s)
- Emily J Labudde
- Department of Pediatrics, Emory University, Atlanta, GA, United States of America.
| | - Scott Gillespie
- Department of Pediatrics, Emory University, Atlanta, GA, United States of America
| | - Anna Wood
- Department of Pediatrics, Emory University, Atlanta, GA, United States of America
| | - Lauren Middlebrooks
- Department of Pediatrics, Division of Emergency Medicine, Emory University, Children's Healthcare of Atlanta, Atlanta, GA, United States of America
| | - Holly C Gooding
- Department of Pediatrics, Division of General Pediatrics and Adolescent Medicine, Emory University, Children's Healthcare of Atlanta, Atlanta, GA, United States of America
| | - Claudia R Morris
- Department of Pediatrics, Division of Emergency Medicine, Emory University, Children's Healthcare of Atlanta, Atlanta, GA, United States of America
| | - Andres Camacho-Gonzalez
- Department of Pediatrics, Division of Infectious Disease, Emory University, Children's Healthcare of Atlanta, Atlanta, GA, United States of America
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Goldstein MH, Moore S, Mohamed M, Byrd R, Curtis MG, Rice WS, Camacho-Gonzalez A, Zanoni BC, Hussen SA. A qualitative analysis examining intersectional stigma among young adults living with HIV in Atlanta, Georgia. PLoS One 2023; 18:e0289821. [PMID: 37561729 PMCID: PMC10414665 DOI: 10.1371/journal.pone.0289821] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Accepted: 07/27/2023] [Indexed: 08/12/2023] Open
Abstract
HIV-related stigma is a barrier to engagement in care for young adults living with HIV. Other intersecting forms of stigma (e.g., racism, sexism, homophobia), may worsen HIV-related stigma and impact engagement in care. From November 2020 to February 2021, we conducted 20 in-depth qualitative interviews among young adults living with HIV attending a large, comprehensive HIV care center in Atlanta, Georgia. Semi-structured interview guides based on Earnshaw and Chaudoir's HIV Stigma Framework and the theory of intersectionality facilitated discussion around experiences with various forms of stigma and its possible influence on healthcare engagement. Using the social-ecological model, we used thematic analysis to contextualize how young adults living with HIV experienced intersectional stigma and enacted, anticipated, and internalized HIV stigma in both healthcare and non-healthcare settings. Most participants identified as male, Black/African American, and gay. Participants described stigma at intrapersonal, interpersonal, clinic, and community levels. Intrapersonal stigma was associated with delayed care seeking, isolation, and fear of disclosure. Interpersonal stigma included discrimination from family and friends and avoidance of close relationships to elude disclosure. At the clinic level, stigma included negative experiences with staff in HIV and non-HIV healthcare settings, which contributed to decreased engagement in care. Stigma in the community included differential treatment from employers, community leaders, and religious community and was associated with feelings of helplessness related to current societal inequalities. Coping/motivating mechanisms for stigma included prioritizing health, eliciting support from the medical care team and peers. Our findings show different intersecting stigmas are barriers to healthcare at multiple levels for young adults living with HIV, potentially exacerbating existing health and social disparities. To improve engagement in care among young adults living with HIV, future interventions should address the different mechanisms of stigma at community, clinic, interpersonal and intrapersonal levels by enhancing social support and improving healthcare structural competency.
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Affiliation(s)
- Madeleine H. Goldstein
- School of Medicine, Emory University, Atlanta, GA, United States of America
- Children’s Healthcare of Atlanta, Atlanta, GA, United States of America
| | - Shamia Moore
- Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, United States of America
| | - Munira Mohamed
- College of Arts and Sciences, Emory University, Atlanta, GA, United States of America
| | - Rosalind Byrd
- School of Medicine, Emory University, Atlanta, GA, United States of America
| | - Michael G. Curtis
- Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, United States of America
| | - Whitney S. Rice
- Department of Behavioral, Social and Health Education Sciences, Rollins School of Public Health, Emory University, Atlanta, GA, United States of America
| | - Andres Camacho-Gonzalez
- School of Medicine, Emory University, Atlanta, GA, United States of America
- Children’s Healthcare of Atlanta, Atlanta, GA, United States of America
| | - Brian C. Zanoni
- School of Medicine, Emory University, Atlanta, GA, United States of America
- Children’s Healthcare of Atlanta, Atlanta, GA, United States of America
- Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, United States of America
| | - Sophia A. Hussen
- School of Medicine, Emory University, Atlanta, GA, United States of America
- Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, United States of America
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Mavragani A, Hagen K, Duarte AP, Escobar C, Batina I, Orozco H, Rodriguez J, Camacho-Gonzalez A, Siegler AJ. Development of a Mobile App to Increase the Uptake of HIV Pre-exposure Prophylaxis Among Latino Sexual Minority Men: Qualitative Needs Assessment. JMIR Form Res 2023; 7:e43844. [PMID: 36625855 PMCID: PMC9947765 DOI: 10.2196/43844] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Revised: 01/05/2023] [Accepted: 01/06/2023] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND HIV disproportionally impacts Latino sexual minority men (SMM). Uptake of pre-exposure prophylaxis (PrEP), an effective biomedical intervention to prevent HIV, is low in this group compared with White SMM. Mobile health technology represents an innovative strategy to increase PrEP uptake among Latino SMM. OBJECTIVE We aimed to describe the qualitative process leading to the development of SaludFindr, a comprehensive HIV prevention mobile app aiming to increase PrEP uptake, HIV testing, and condom use by Latino SMM. METHODS We conducted 13 in-depth interviews with Latino SMM living in the Atlanta area to explore their main barriers and facilitators to PrEP uptake and to analyze their opinions of potential SaludFindr app functionalities. To explore potential app functions, we used HealthMindr, an existing HIV prevention app, as a template and added new proposed features intended to address the specific community needs. RESULTS We identified general PrEP uptake barriers that, although common among non-Latino groups, had added complexities such as the influence of religion and family on stigma. Low perceived PrEP eligibility, intersectional stigma, lack of insurance, cost concerns, and misconceptions about PrEP side effects were described as general barriers. We also identified Latino-specific barriers that predominantly hinder access to existing services, including a scarcity of PrEP clinics that are prepared to provide culturally concordant services, limited availability of Spanish language information related to PrEP access, distrust of peers as credible sources of information, perceived ineligibility for low-cost services owing to undocumented status, fear of immigration authorities, and competing work obligations that prevent PrEP clinic attendance. Health care providers represented a trusted source of information, and 3 provider characteristics were identified as PrEP facilitators: familiarity with prescribing PrEP; being Latino; and being part of lesbian, gay, bisexual, transgender, queer, intersex, and asexual (LGBTQIA+) group or ally. The proposed app was very well accepted, with a particularly high interest in features that facilitate PrEP access, including a tailored list of clinics that meet the community needs and a private platform to seek PrEP information. Spanish language availability and free or low-cost PrEP care represented the 2 main clinic criteria that would facilitate PrEP uptake. Latino representation in clinic staff and providers; clinic perception as a safe space for undocumented patients; and LGBTQIA+ representation was listed as additional criteria. Only 8 of 47 clinics listed on the Centers for Diseases Control and Prevention PrEP locator website for the Atlanta area fulfilled at least 2 main criteria. CONCLUSIONS This study provides further evidence of the substantial PrEP uptake barriers that Latino SMM face; exposes the urgent need to increase the number of accessible PrEP-providing clinics for Latino SMM; and proposes an innovative, community-driven, and mobile technology-based tool as a future intervention to overcome some of these barriers.
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Affiliation(s)
| | - Kimberly Hagen
- Department of Behavioral, Social and Health Education Sciences, Rollins School of Public Health, Emory University, Atlanta, GA, United States
| | - Ana Paula Duarte
- Centers for Disease Control and Prevention, Atlanta, GA, United States
| | | | - Isabella Batina
- Division of Infectious Diseases, Emory University School of Medicine, Atlanta, GA, United States
| | - Humberto Orozco
- Division of Infectious Diseases, Emory University School of Medicine, Atlanta, GA, United States
| | - Josue Rodriguez
- Emory University School of Medicine, Atlanta, GA, United States
| | | | - Aaron J Siegler
- Department of Behavioral, Social and Health Education Sciences, Rollins School of Public Health, Emory University, Atlanta, GA, United States
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Castellano C, Loerinc L, Khan F, Cleary P, Gutierrez M, White M, McCool-Myers M, Camacho-Gonzalez A. Peer outreach program to improve condom education and use in young men who have sex with men living with HIV in Atlanta, GA. Am J Med Sci 2023. [DOI: 10.1016/s0002-9629(23)00524-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
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Gutman CK, Newton N, Duda E, Alevy R, Palmer K, Wetzel M, Figueroa J, Griffiths M, Koyama A, Middlebrooks L, Camacho-Gonzalez A, Morris CR. Comparison of Targeted and Routine Adolescent HIV Screening in a Pediatric Emergency Department. Pediatr Emerg Care 2022; 38:e1613-e1619. [PMID: 35686965 DOI: 10.1097/pec.0000000000002772] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES The aims of the study were (1) to compare targeted and routine HIV screening in a pediatric emergency department (PED) and (2) to compare provider documented HIV risk assessment with adolescent perception of HIV risk assessment conducted during the PED visit. METHODS This prospective study ran concurrent to a PED routine HIV screening pilot. Adolescents could be tested for HIV by the PED provider per usual care (targeted testing); if not tested, they were approached for the routine screening pilot. A subset of adolescents completed a questionnaire on HIV risk. χ 2 analysis compared adolescents with targeted testing and routine screening. HIV-tested patients were asked if HIV risk was assessed; κ analysis compared this with documentation in the provider note. RESULTS Over 4 months, 107 adolescents received targeted testing and 344 received routine screening. One 14-year-old patient tested positive by routine screening; this adolescent had 2 PED visits without targeted testing within 60 days. Compared with routine screening, adolescents with targeted testing were more likely female (82% vs 57%, P < 0.001), 16 years or older (71% vs 44%, P < 0.001), or had genitourinary/gynecologic concerns (48% vs 6%, P < 0.001). Adolescents with HIV risk factors were missed by targeted testing but received routine screening. Adolescents with documented HIV risk assessment were more likely to receive targeted testing. There was moderate agreement (κ = 0.61) between provider documentation and adolescent perception of HIV risk assessment. CONCLUSIONS There are gaps in PED HIV risk assessment and testing, which may miss opportunities to diagnose adolescent HIV. Routine HIV screening addresses these gaps and expands adolescent HIV testing in the PED.
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Affiliation(s)
| | | | | | | | | | - Martha Wetzel
- From the Department of Pediatrics, Emory University School of Medicine, Atlanta, GA
| | - Janet Figueroa
- From the Department of Pediatrics, Emory University School of Medicine, Atlanta, GA
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Amin O, Rostad CA, Gonzalez M, Rostad BS, Caltharp S, Quincer E, Betke BA, Gottdenker NL, Wilson JJ, Shane AL, Elmontser M, Camacho-Gonzalez A, Senior T, Smith O, Anderson EJ, Yildirim I. CAT-SCRATCH DISEASE: 9 YEARS OF EXPERIENCE AT A PEDIATRIC CENTER. Open Forum Infect Dis 2022; 9:ofac426. [PMID: 36072697 PMCID: PMC9439574 DOI: 10.1093/ofid/ofac426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Accepted: 08/18/2022] [Indexed: 11/14/2022] Open
Abstract
ABSTRACT
Background
A more complete understanding of the epidemiology, risk factors, and clinical features of cat scratch disease (CSD) in children could help guide patient care.
Methods
We conducted a retrospective analysis of children presenting to a tertiary pediatric hospital system in Atlanta, Georgia between January 1, 2010, and December 31, 2018 who had serology, PCR and/or cytopathological results consistent with a Bartonella henselae infection. We also retrospectively reviewed veterinary diagnostic results performed at the University of Georgia (UGA) from 2018-2020 to ascertain the burden of bartonellosis in companion animals within the state.
Results
We identified 304 children with CSD over 9 years with the largest proportion of diagnoses made during August (41/304, 13.5%) and September (47/304, 15.5%). The median age of child cases was 8.1 years (interquartile range (IQR) 5.4-12.1]; 156 (51.3%) were female; 242/262 (92.4%) reported feline exposure, while 55/250 (22%) reported canine exposure of those with exposure histories documented in the medical record. Although lymphadenopathy was present on physical examination in the majority of cases (78.8%), atypical presentations lacking lymphadenopathy were also common (63/304, 20.7%). Among children with radiographic imaging, 20/55 (36.4%) had splenomegaly and 21/55 (38.1%) had splenic and/or hepatic microabscesses. Among veterinary data, Bartonella seroprevalence was 12/146 (8.2%), all among canines, with a geographic distribution that spanned the state of Georgia.
Conclusion
Distinguishing clinical features of CSD included subacute regional lymphadenopathy in school-aged children in the late summer, almost all of whom had cat exposure. Atypical clinical manifestations of CSD were also commonly identified.
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Affiliation(s)
- Omayma Amin
- Department of Pediatrics, Emory University School of Medicine and Children’s Healthcare of Atlanta , Atlanta, GA , USA
| | - Christina A Rostad
- Department of Pediatrics, Emory University School of Medicine and Children’s Healthcare of Atlanta , Atlanta, GA , USA
| | - Mark Gonzalez
- Department of Clinical Microbiology, Children’s Healthcare of Atlanta , Atlanta, GA , USA
| | - Bradley S Rostad
- Division of Pediatric Radiology, Children's Healthcare of Atlanta, Emory University School of Medicine , Atlanta, GA , USA
| | - Shelley Caltharp
- Department of Pathology and Laboratory Medicine, Children’s Healthcare of Atlanta , Atlanta, GA , USA
- Department of Pathology, Emory University School of Medicine , Atlanta, GA , USA
| | - Elizabeth Quincer
- Department of Pediatrics, Emory University School of Medicine and Children’s Healthcare of Atlanta , Atlanta, GA , USA
| | - Briana A Betke
- Department of Veterinary Pathology, College of Veterinary Medicine, University of Georgia , Athens, Georgia USA
| | - Nicole L Gottdenker
- Department of Veterinary Pathology, College of Veterinary Medicine, University of Georgia , Athens, Georgia USA
| | - Jonathan J Wilson
- Department of Veterinary Pathology, College of Veterinary Medicine, University of Georgia , Athens, Georgia USA
| | - Andi L Shane
- Department of Pediatrics, Emory University School of Medicine and Children’s Healthcare of Atlanta , Atlanta, GA , USA
| | - Mohnd Elmontser
- Department of Pediatrics, Emory University School of Medicine and Children’s Healthcare of Atlanta , Atlanta, GA , USA
| | - Andres Camacho-Gonzalez
- Department of Pediatrics, Emory University School of Medicine and Children’s Healthcare of Atlanta , Atlanta, GA , USA
| | - Tal Senior
- Department of Advanced Analytics, Children’s Healthcare of Atlanta , Atlanta, GA , USA
| | - Oliver Smith
- Department of Pediatrics, Emory University School of Medicine and Children’s Healthcare of Atlanta , Atlanta, GA , USA
| | - Evan J Anderson
- Department of Pediatrics, Emory University School of Medicine and Children’s Healthcare of Atlanta , Atlanta, GA , USA
- Department of Medicine, Emory University School of Medicine , Atlanta, GA , USA
| | - Inci Yildirim
- Department of Pediatrics, Emory University School of Medicine and Children’s Healthcare of Atlanta , Atlanta, GA , USA
- Department of Epidemiology, Rollins School of Public Health, Emory University , Atlanta GA , USA
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10
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Teherani M, Banskota S, Camacho-Gonzalez A, Smith AGC, Anderson EJ, Kao CM, Crepy D’Orleans C, Shane AL, Lu A, Jaggi P. Intent to Vaccinate SARS-CoV-2 Infected Children in US Households: A Survey. Vaccines (Basel) 2021; 9:1049. [PMID: 34579286 PMCID: PMC8473386 DOI: 10.3390/vaccines9091049] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Revised: 09/15/2021] [Accepted: 09/17/2021] [Indexed: 11/16/2022] Open
Abstract
A paucity of data exists evaluating a guardian's intent to vaccinate their child against COVID-19 in the United States. We administered 102 first (April-November 2020) and 45 second (December-January 2020-2021) surveys to guardians of children (<18 years) who had a laboratory-confirmed diagnosis of COVID-19 and assessed their intent to give a COVID-19 vaccine to their child, when one becomes available. The first and second surveys of the same cohort of guardians were conducted before and following the press releases detailing the adult Pfizer-BioNTech and Moderna Phase 3 results. Both surveys included an intent-to-vaccinate question using the subjective language of "if a safe and effective vaccine" became available, and a second question was added to second surveys using the objective language of "would prevent 19 of 20 people from getting disease". When using subjective language, 24 of 45 (53%) guardians endorsed vaccine administration for their children in the first survey, which decreased to 21 (46%) in the second survey. When adding objective language, acceptance of vaccination increased to 31 (69%, p = 0.03). Common reasons for declining vaccination were concerns about adverse effects and/or vaccine safety. Providing additional facts on vaccine efficacy increased vaccine acceptance. Evidence-based strategies are needed to increase pediatric COVID-19 vaccine uptake.
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Affiliation(s)
- Mehgan Teherani
- Department of Pediatrics, Emory University School of Medicine, Children’s Healthcare of Atlanta, Atlanta, GA 30322, USA; (A.C.-G.); (E.J.A.); (A.L.S.)
| | - Samridhi Banskota
- Emory University School of Medicine, Atlanta, GA 30322, USA; (S.B.); (A.G.C.S.); (A.L.)
| | - Andres Camacho-Gonzalez
- Department of Pediatrics, Emory University School of Medicine, Children’s Healthcare of Atlanta, Atlanta, GA 30322, USA; (A.C.-G.); (E.J.A.); (A.L.S.)
| | - Alison G. C. Smith
- Emory University School of Medicine, Atlanta, GA 30322, USA; (S.B.); (A.G.C.S.); (A.L.)
| | - Evan J. Anderson
- Department of Pediatrics, Emory University School of Medicine, Children’s Healthcare of Atlanta, Atlanta, GA 30322, USA; (A.C.-G.); (E.J.A.); (A.L.S.)
| | - Carol M. Kao
- Department of Pediatrics, Washington University School of Medicine, St. Louis, MO 63110, USA;
| | | | - Andi L. Shane
- Department of Pediatrics, Emory University School of Medicine, Children’s Healthcare of Atlanta, Atlanta, GA 30322, USA; (A.C.-G.); (E.J.A.); (A.L.S.)
| | - Austin Lu
- Emory University School of Medicine, Atlanta, GA 30322, USA; (S.B.); (A.G.C.S.); (A.L.)
| | - Preeti Jaggi
- Department of Pediatrics, Emory University School of Medicine, Children’s Healthcare of Atlanta, Atlanta, GA 30322, USA; (A.C.-G.); (E.J.A.); (A.L.S.)
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11
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Kuypers FA, Rostad CA, Anderson EJ, Chahroudi A, Jaggi P, Wrammert J, Mantus G, Basu R, Harris F, Hanberry B, Camacho-Gonzalez A, Manoranjithan S, Vos M, Brown LA, Morris CR. Secretory phospholipase A2 in SARS-CoV-2 infection and multisystem inflammatory syndrome in children (MIS-C). Exp Biol Med (Maywood) 2021; 246:2543-2552. [PMID: 34255566 PMCID: PMC8649422 DOI: 10.1177/15353702211028560] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
Secretory phospholipase 2 (sPLA2) acts as a mediator between proximal and distal events of the inflammatory cascade. Its role in SARS-CoV-2 infection is unknown, but could contribute to COVID-19 inflammasome activation and cellular damage. We present the first report of plasma sPLA2 levels in adults and children with COVID-19 compared with controls. Currently asymptomatic adults with a history of recent COVID-19 infection (≥4 weeks before) identified by SARS-CoV-2 IgG antibodies had sPLA2 levels similar to those who were seronegative (9 ± 6 vs.17 ± 28 ng/mL, P = 0.26). In contrast, children hospitalized with severe COVID-19 had significantly elevated sPLA2 compared with those with mild or asymptomatic SARS-CoV-2 infection (269 ± 137 vs. 2 ± 3 ng/mL, P = 0.01). Among children hospitalized with multisystem inflammatory syndrome in children (MIS-C), all had severe disease requiring pediatric intensive care unit (PICU) admission. sPLA2 levels were significantly higher in those with acute illness <10 days versus convalescent disease ≥10 days (540 ± 510 vs. 2 ± 1, P = 0.04). Thus, sPLA2 levels correlated with COVID-19 severity and acute MIS-C in children, implicating a role in inflammasome activation and disease pathogenesis. sPLA2 may be a useful biomarker to stratify risk and guide patient management for children with acute COVID-19 and MIS-C. Therapeutic compounds targeting sPLA2 and inflammasome activation warrant consideration.
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Affiliation(s)
- Frans A Kuypers
- Division of Hematology, Department of Pediatrics, University of California, San Francisco, CA 94609, USA
| | - Christina A Rostad
- Department of Pediatrics1371, School of Medicine, Emory University, Atlanta, GA 30322, USA.,Children's Healthcare of Atlanta, Atlanta, GA 30322, USA.,Center for Childhood Infections and Vaccines of Children's Healthcare of Atlanta and Emory University, Atlanta, GA 30322, USA
| | - Evan J Anderson
- Department of Pediatrics1371, School of Medicine, Emory University, Atlanta, GA 30322, USA.,Children's Healthcare of Atlanta, Atlanta, GA 30322, USA.,Center for Childhood Infections and Vaccines of Children's Healthcare of Atlanta and Emory University, Atlanta, GA 30322, USA.,Department of Medicine, School of Medicine, Emory University, Atlanta, GA 30322, USA
| | - Ann Chahroudi
- Department of Pediatrics1371, School of Medicine, Emory University, Atlanta, GA 30322, USA.,Children's Healthcare of Atlanta, Atlanta, GA 30322, USA.,Center for Childhood Infections and Vaccines of Children's Healthcare of Atlanta and Emory University, Atlanta, GA 30322, USA
| | - Preeti Jaggi
- Department of Pediatrics1371, School of Medicine, Emory University, Atlanta, GA 30322, USA.,Children's Healthcare of Atlanta, Atlanta, GA 30322, USA
| | - Jens Wrammert
- Department of Pediatrics1371, School of Medicine, Emory University, Atlanta, GA 30322, USA.,Center for Childhood Infections and Vaccines of Children's Healthcare of Atlanta and Emory University, Atlanta, GA 30322, USA
| | - Grace Mantus
- Department of Pediatrics1371, School of Medicine, Emory University, Atlanta, GA 30322, USA
| | - Rajit Basu
- Department of Pediatrics1371, School of Medicine, Emory University, Atlanta, GA 30322, USA.,Children's Healthcare of Atlanta, Atlanta, GA 30322, USA
| | - Frank Harris
- Department of Pediatrics1371, School of Medicine, Emory University, Atlanta, GA 30322, USA
| | - Bradley Hanberry
- Department of Pediatrics1371, School of Medicine, Emory University, Atlanta, GA 30322, USA
| | - Andres Camacho-Gonzalez
- Department of Pediatrics1371, School of Medicine, Emory University, Atlanta, GA 30322, USA.,Children's Healthcare of Atlanta, Atlanta, GA 30322, USA.,Center for Childhood Infections and Vaccines of Children's Healthcare of Atlanta and Emory University, Atlanta, GA 30322, USA
| | | | - Miriam Vos
- Department of Pediatrics1371, School of Medicine, Emory University, Atlanta, GA 30322, USA.,Children's Healthcare of Atlanta, Atlanta, GA 30322, USA.,Center for Clinical and Translational Research, Children's Healthcare of Atlanta and Emory University, Atlanta, GA 30322, USA
| | - Lou Ann Brown
- Department of Pediatrics1371, School of Medicine, Emory University, Atlanta, GA 30322, USA
| | - Claudia R Morris
- Department of Pediatrics1371, School of Medicine, Emory University, Atlanta, GA 30322, USA.,Children's Healthcare of Atlanta, Atlanta, GA 30322, USA.,Center for Clinical and Translational Research, Children's Healthcare of Atlanta and Emory University, Atlanta, GA 30322, USA
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12
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Goldman DL, Aldrich ML, Hagmann SHF, Bamford A, Camacho-Gonzalez A, Lapadula G, Lee P, Bonfanti P, Carter CC, Zhao Y, Telep L, Pikora C, Naik S, Marshall N, Katsarolis I, Das M, DeZure A, Desai P, Cao H, Chokkalingam AP, Osinusi A, Brainard DM, Méndez-Echevarría A. Compassionate Use of Remdesivir in Children With Severe COVID-19. Pediatrics 2021; 147:peds.2020-047803. [PMID: 33883243 DOI: 10.1542/peds.2020-047803] [Citation(s) in RCA: 63] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/10/2021] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES Remdesivir shortens time to recovery in adults with severe coronavirus disease 2019 (COVID-19), but its efficacy and safety in children are unknown. We describe outcomes in children with severe COVID-19 treated with remdesivir. METHODS Seventy-seven hospitalized patients <18 years old with confirmed severe acute respiratory syndrome coronavirus 2 infection received remdesivir through a compassionate-use program between March 21 and April 22, 2020. The intended remdesivir treatment course was 10 days (200 mg on day 1 and 100 mg daily subsequently for children ≥40 kg and 5 mg/kg on day 1 and 2.5 mg/kg daily subsequently for children <40 kg, given intravenously). Clinical data through 28 days of follow-up were collected. RESULTS Median age was 14 years (interquartile range 7-16, range <2 months to 17 years). Seventy-nine percent of patients had ≥1 comorbid condition. At baseline, 90% of children required supplemental oxygen and 51% required invasive ventilation. By day 28 of follow-up, 88% of patients had a decreased oxygen-support requirement, 83% recovered, and 73% were discharged. Among children requiring invasive ventilation at baseline, 90% were extubated, 80% recovered, and 67% were discharged. There were 4 deaths, of which 3 were attributed to COVID-19. Remdesivir was well tolerated, with a low incidence of serious adverse events (16%). Most adverse events were related to COVID-19 or comorbid conditions. Laboratory abnormalities, including elevations in transaminase levels, were common; 61% were grades 1 or 2. CONCLUSIONS Among 77 children treated with remdesivir for severe COVID-19, most recovered and the rate of serious adverse events was low.
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Affiliation(s)
| | | | - Stefan H F Hagmann
- Steven and Alexandra Cohen Children's Medical Center, Northwell Health, New York, New York
| | - Alasdair Bamford
- Great Ormond Street Hospital for Children National Health Service Foundation Trust, London, United Kingdom
| | | | | | - Philip Lee
- Children's Hospital at Montefiore, New York, New York
| | | | | | - Yang Zhao
- Gilead Sciences Inc, Foster City, California; and
| | - Laura Telep
- Gilead Sciences Inc, Foster City, California; and
| | | | - Sarjita Naik
- Gilead Sciences Inc, Foster City, California; and
| | | | | | - Moupali Das
- Gilead Sciences Inc, Foster City, California; and
| | - Adam DeZure
- Gilead Sciences Inc, Foster City, California; and
| | - Polly Desai
- Gilead Sciences Inc, Foster City, California; and
| | - Huyen Cao
- Gilead Sciences Inc, Foster City, California; and
| | | | - Anu Osinusi
- Gilead Sciences Inc, Foster City, California; and
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13
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Tanner AE, Dowshen N, Philbin MM, Rulison KL, Camacho-Gonzalez A, Lee S, Moore SJ, Fortenberry JD, Hussen SA. An Intervention for the Transition From Pediatric or Adolescent to Adult-Oriented HIV Care: Protocol for the Development and Pilot Implementation of iTransition. JMIR Res Protoc 2021; 10:e24565. [PMID: 33825691 PMCID: PMC8075294 DOI: 10.2196/24565] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Revised: 01/21/2021] [Accepted: 02/09/2021] [Indexed: 11/13/2022] Open
Abstract
Background In the United States, adolescents and young adults are disproportionately affected by HIV and have poorer HIV-related health outcomes than adults. Health care transition (HCT) from pediatric or adolescent to adult-oriented HIV care is associated with disruptions to youths’ care retention, medication adherence, and viral suppression. However, no evidence-based interventions exist to improve HCT outcomes for youth living with HIV. Objective There are 2 phases of this project. Phase 1 involves the iterative development and usability testing of a Social Cognitive Theory–based mobile health (mHealth) HIV HCT intervention (iTransition). In phase 2, we will conduct a pilot implementation trial to assess iTransition’s feasibility and acceptability and to establish preliminary efficacy among youth and provider participants. Methods The iterative phase 1 development process will involve in-person and virtual meetings and a design team comprising youth living with HIV and health care providers. The design team will both inform the content and provide feedback on the look, feel, and process of the iTransition intervention. In phase 2, we will recruit 100 transition-eligible youth across two clinical sites in Atlanta, Georgia, and Philadelphia, Pennsylvania, to participate in the historical control group (n=50; data collection only) or the intervention group (n=50) in a pilot implementation trial. We will also recruit 28 provider participants across the pediatric or adolescent and adult clinics at the two sites. Data collection will include electronic medical chart abstraction for clinical outcomes as well as surveys and interviews related to demographic and behavioral characteristics; Social Cognitive Theory constructs; and intervention feasibility, acceptability, and use. Analyses will compare historical control and intervention groups in terms of HCT outcomes, including adult care linkage (primary), care retention, and viral suppression (secondary). Interview data will be analyzed using content analysis to understand the experience with use and acceptability. Results Phase 1 (development) of iTransition research activities began in November 2019 and is ongoing. The data collection for the phase 2 pilot implementation trial is expected to be completed in January 2023. Final results are anticipated in summer 2023. Conclusions The development and pilot implementation trial of the iTransition intervention will fill an important gap in understanding the role of mHealth interventions to support HCT outcomes for youth living with HIV. International Registered Report Identifier (IRRID) DERR1-10.2196/24565
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Affiliation(s)
- Amanda E Tanner
- Department of Public Health Education, University of North Carolina Greensboro, Greensboro, NC, United States
| | - Nadia Dowshen
- Craig-Dalsimer Division of Adolescent Medicine, Children's Hospital of Philadelphia, Philadelphia, PA, United States.,Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
| | - Morgan M Philbin
- Department of Sociomedical Sciences, Columbia University Mailman School of Public Health, New York, NY, United States
| | - Kelly L Rulison
- Department of Human Development and Family Studies, The Pennsylvania State University, State College, PA, United States
| | - Andres Camacho-Gonzalez
- Department of Pediatrics, Division of Infectious Diseases, Emory University School of Medicine, Atlanta, GA, United States
| | - Susan Lee
- Craig-Dalsimer Division of Adolescent Medicine, Children's Hospital of Philadelphia, Philadelphia, PA, United States
| | - Shamia J Moore
- Hubert Department of Global Health, Emory University Rollins School of Public Health, Atlanta, GA, United States
| | - J Dennis Fortenberry
- Division of Adolescent Medicine, Indiana University School of Medicine, Indianapolis, IN, United States
| | - Sophia A Hussen
- Hubert Department of Global Health, Emory University Rollins School of Public Health, Atlanta, GA, United States.,Department of Medicine, Division of Infectious Diseases, Emory University School of Medicine, Atlanta, GA, United States
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14
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Morris CR, Sullivan P, Mantus G, Sanchez T, Zlotorzynska M, Hanberry B, Iyer S, Heilman S, Camacho-Gonzalez A, Figueroa J, Manoranjithan S, Leake D, Mendis R, Cleeton R, Chen C, Krieger R, Bush P, Hughes T, Little WK, Suthar MS, Wrammert J, Vos MB. Prevalence of SARS-CoV-2 antibodies in pediatric healthcare workers. Int J Infect Dis 2021; 105:474-481. [PMID: 33722686 PMCID: PMC7952267 DOI: 10.1016/j.ijid.2021.03.017] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2021] [Revised: 02/28/2021] [Accepted: 03/08/2021] [Indexed: 01/08/2023] Open
Abstract
Objectives To determine SARS-CoV-2-antibody prevalence in pediatric healthcare workers (pHCWs). Design Baseline prevalence of anti-SARS-CoV-2-IgG was assessed in a prospective cohort study from a large pediatric healthcare facility. Prior SARS-CoV-2 testing history, potential risk factors and anxiety level about COVID-19 were determined. Prevalence difference between emergency department (ED)-based and non-ED-pHCWs was modeled controlling for those covariates. Chi-square test-for-trend was used to examine prevalence by month of enrollment. Results Most of 642 pHCWs enrolled were 31-40years, female and had no comorbidities. Half had children in their home, 49% had traveled, 42% reported an illness since January, 31% had a known COVID-19 exposure, and 8% had SARS-CoV-2 PCR testing. High COVID-19 pandemic anxiety was reported by 71%. Anti-SARS-CoV-2-IgG prevalence was 4.1%; 8.4% among ED versus 2.0% among non-ED pHCWs (p < 0.001). ED-work location and known COVID-19 exposure were independent risk factors. 31% of antibody-positive pHCWs reported no symptoms. Prevalence significantly (p < 0.001) increased from 3.0% in April–June to 12.7% in July–August. Conclusions Anti-SARS-CoV-2-IgG prevalence was low in pHCWs but increased rapidly over time. Both working in the ED and exposure to a COVID-19-positive contact were associated with antibody-seropositivity. Ongoing universal PPE utilization is essential. These data may guide vaccination policies to protect front-line workers.
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Affiliation(s)
- Claudia R Morris
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, United States; Children's Healthcare of Atlanta, Atlanta, GA, United States; Center for Clinical and Translational Research, of Children's Healthcare of Atlanta and Emory University, Atlanta, GA, United States.
| | - Patrick Sullivan
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, United States
| | - Grace Mantus
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, United States
| | - Travis Sanchez
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, United States
| | - Maria Zlotorzynska
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, United States
| | - Bradley Hanberry
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, United States
| | - Srikant Iyer
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, United States; Children's Healthcare of Atlanta, Atlanta, GA, United States
| | - Stacy Heilman
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, United States
| | - Andres Camacho-Gonzalez
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, United States; Children's Healthcare of Atlanta, Atlanta, GA, United States; Center for Childhood Infections and Vaccines of Children's Healthcare of Atlanta and Emory University, Atlanta, GA, United States
| | - Janet Figueroa
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, United States
| | | | - Deborah Leake
- Children's Healthcare of Atlanta, Atlanta, GA, United States
| | - Reshika Mendis
- Children's Healthcare of Atlanta, Atlanta, GA, United States
| | - Rebecca Cleeton
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, United States
| | - Christie Chen
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, United States
| | - Rachel Krieger
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, United States
| | - Patricia Bush
- Children's Healthcare of Atlanta, Atlanta, GA, United States
| | - Tiffany Hughes
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, United States
| | - Wendalyn K Little
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, United States; Children's Healthcare of Atlanta, Atlanta, GA, United States
| | - Mehul S Suthar
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, United States; Center for Childhood Infections and Vaccines of Children's Healthcare of Atlanta and Emory University, Atlanta, GA, United States
| | - Jens Wrammert
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, United States; Center for Childhood Infections and Vaccines of Children's Healthcare of Atlanta and Emory University, Atlanta, GA, United States
| | - Miriam B Vos
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, United States; Children's Healthcare of Atlanta, Atlanta, GA, United States; Center for Clinical and Translational Research, of Children's Healthcare of Atlanta and Emory University, Atlanta, GA, United States
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15
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Kao CM, Thomas AS, Camacho-Gonzalez A, Sheth AN. 1145. The Role of Maternal Vaccination on Healthcare Visits for Acute Respiratory Infections in HIV-Exposed but Uninfected (HEU) Infants. Open Forum Infect Dis 2020. [PMCID: PMC7777639 DOI: 10.1093/ofid/ofaa439.1331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
HEU infants remain at higher risk for hospitalization and severe infection from common childhood illnesses. Maternal immunization during pregnancy with influenza and tetanus, diphtheria, pertussis (Tdap) vaccine is recommended and effective at protecting infants from vaccine-preventable infections.
Methods
We conducted a retrospective cohort study of pregnant women living with HIV (WLWH) who delivered and received prenatal care at Grady Memorial Hospital (GMH) between November 1, 2012 and June 30, 2018. Vaccination history was ascertained through the Georgia Registry of Immunization Transactions and Services or by review of electronic medical record. Mother and infant charts were reviewed. We defined acute respiratory infection (ARI) as infants who presented with symptoms or an admitting diagnosis suggestive of an ARI. Relative risks (RR) of identified care visits (clinic, ED/urgent care, hospitalization) in the 6 months post-partum between WLWH with varying vaccinations were compared with 95% confidence intervals.
Results
236 WLWH who delivered at GMH were identified (Table 1). Of those, 66 (28%) received only influenza, 32 (14%) received only Tdap vaccine, 64 (27%) received both and 74 (31%) did not receive any vaccines during pregnancy. There was a trend towards decreased risk of a clinic visit, emergency department/urgent care visit, or any healthcare-associated visit in the first 6 months of life for an ARI in infants born to mothers who received any vaccine during pregnancy versus none although not reaching statistical significance (Table 2). There was a trend towards decreased risk of hospitalization for an ARI in the first six months of life in infants born to mothers who received both influenza and Tdap vaccines during pregnancy versus unvaccinated (RR 0.55, 95%CI: 0.14-2.22). Infants born to mothers vaccinated tended to have higher gestational age than those that did not (Table 3).
Table 1. Demographic and Characteristics of Mothers
Table 2. Relative Risk of a Healthcare Visit in the first 6 months of life for URI in Vaccinated vs Unvaccinated Mothers
Table 3. Birth outcomes in HEU infants of Vaccinated vs Unvaccinated Mothers
Conclusion
There was a lower risk of healthcare visits for ARI in the first 6-months of life in HEU infants born to mothers who received antepartum vaccinations. Although not statistically significant, larger studies are needed to fully characterize the immune responses in this unique population.
Disclosures
All Authors: No reported disclosures
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Affiliation(s)
| | | | - Andres Camacho-Gonzalez
- Ponce Family and Youth Clinic, Grady Infectious Diseases Program, Grady Health Systems, Atlanta, GA
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16
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Loerinc L, Scheel A, Jordan-Thompson SL, Gillespie S, Camacho-Gonzalez A. 1537. Incidence, Reinfection, and Discrepancy Between Site Positivity and Reported Sexual Practice of Sexually Transmitted Infections in HIV-Positive Adolescents and Young Adults in Atlanta, GA. Open Forum Infect Dis 2020. [PMCID: PMC7777717 DOI: 10.1093/ofid/ofaa439.1717] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Background HIV-positive adolescents and young adults (AYAs) are disproportionately affected by sexually transmitted infections (STIs). Despite national recommendations, STI screening remains low. Incomplete screening in addition to inconsistent reported sexual practices may lead to missed infections. This study aimed to determine the incidence and reinfection rates of co-STIs in HIV-positive AYAs and the discrepancy between site positivity and self-reported sexual history in this group. Methods Retrospective chart review was conducted for all patients aged 13-24 at Grady Ponce and Family Youth Clinic in Atlanta, GA from 2009-2018. Data were collected on demographics and STI events. STIs included gonorrhea (GC), chlamydia (CT), human papillomavirus (HPV), syphilis, trichomonas, herpes simplex virus (HSV), lymphogranuloma venereum (LGV), hepatitis C (HCV), bacterial vaginosis (BV), and chancroid. First STI incidence and incidence of reinfections were calculated by dividing new cases over corresponding person follow-up time. Results 621 sexually active HIV-positive AYAs were included. The mean age at first observation was 18.7 (±3.29) years. 72.1% of patients were male, 92.3% were Black, and 79.7% were horizontally infected. 83.7% of patients had at least one STI during the study period. The overall first STI incidence rate was 35.8 per 100 person-years with HPV, GC, CT, and syphilis as the most common STIs reported (Table 1). The overall recurrent incidence rate was 72.1 per 100 person-years with GC, CT, and syphilis as the most common recurrent infections (Table 1). Of all GC and CT infections, the majority were rectal (48.7% and 49.9%, respectively) (Table 2). Only 65.8% of patients with rectal GC and 68.5% with rectal CT infections reported recent receptive anal sex (Table 3). Table 1: First and recurrent incidence rates of any STI and individual STIs per 100 person-years ![]()
Table 2: STIs by site, all infections ![]()
Table 3: Reported exposure history vs. STI site positivity ![]()
Conclusion Our study demonstrates disproportionately high incidence and reinfection rates of co-STIs in HIV-positive AYAs. Furthermore, many patients did not report exposure at their site of infection. If screening is done based off reported exposure history alone, many infections may be missed. Our data support the urgent need for increased STI screening in this population, including routine extragenital testing for GC and CT even without reported exposure at these sites. Disclosures All Authors: No reported disclosures
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Affiliation(s)
- Leah Loerinc
- Emory University School of Medicine, Atlanta, Georgia
| | - Amy Scheel
- Emory University School of Medicine, Atlanta, Georgia
| | | | - Scott Gillespie
- Emory University School of Medicine, Department of Pediatrics, Atlanta, GA
| | - Andres Camacho-Gonzalez
- Ponce Family and Youth Clinic, Grady Infectious Diseases Program, Grady Health Systems, Atlanta, GA
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17
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Morris C, Camacho-Gonzalez A, Chen C, Heilman S, Iyer S, Mantus G, Sanchez T, Sullivan P, Suthar M, Wrammert J, Vos M. 321 Prevalence of SARS-CoV-2 Antibodies in Pediatric Health Care Workers in Atlanta, Georgia. Ann Emerg Med 2020. [PMCID: PMC7598755 DOI: 10.1016/j.annemergmed.2020.09.336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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18
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Gutman CK, Middlebrooks L, Camacho-Gonzalez A, Shah B, Belay Z, Morris CR. Asymptomatic Adolescent HIV: Identifying a Role for Universal HIV Screening in the Pediatric Emergency Department. AIDS Patient Care STDS 2020; 34:373-379. [PMID: 32799540 PMCID: PMC7480725 DOI: 10.1089/apc.2020.0033] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Adolescents account for most undiagnosed HIV infections in the United States. Although the Centers for Disease Control and Prevention (CDC) recommends universal HIV screening for all patients ≥13 years, <10% of adolescents have been tested for HIV. To identify earlier opportunities for adolescent HIV prevention and diagnosis in a region of high HIV prevalence, we sought to describe pediatric emergency department (PED) visits made by a retrospective cohort of adolescents who were later diagnosed with HIV as young adults (<25 years) through an adult emergency department (ED) universal HIV screening program. CD4+ count was used to estimate the time of HIV infection before diagnosis and all PED visits in the 10 years before diagnosis were analyzed. Universal HIV screening in the adult ED diagnosed 193 young adults (median 22 years; 90% men; 29% stage 3); 70% had CD4+ at diagnosis that was used to estimate time of infection (mean 3.8 years). Thirty-eight HIV-infected young adults had a total of 109 PED visits in the 10 years before HIV diagnosis. Sexual history was documented in 12% of PED visits and a sexually transmitted infection test was sent in 6%. Ten HIV-infected young adults had 26 PED visits during the time in which they were likely already infected with HIV, each a potential missed opportunity for earlier diagnosis. HIV-infected and at-risk adolescents are underrecognized in PED visits. Implementation of CDC-recommended universal screening may lead to earlier diagnoses and improve outcomes; the PED may also be critical in identifying adolescents eligible for preexposure prophylaxis.
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Affiliation(s)
- Colleen K. Gutman
- Division of Pediatric Emergency Medicine, Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia, USA
- Children's Healthcare of Atlanta, Atlanta, Georgia, USA
| | - Lauren Middlebrooks
- Division of Pediatric Emergency Medicine, Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia, USA
- Children's Healthcare of Atlanta, Atlanta, Georgia, USA
| | - Andres Camacho-Gonzalez
- Children's Healthcare of Atlanta, Atlanta, Georgia, USA
- Division of Pediatric Infectious Disease, Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Bijal Shah
- Department of Emergency Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
- Grady Health System, Atlanta, Georgia, USA
| | - Zena Belay
- Department of Emergency Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Claudia R. Morris
- Division of Pediatric Emergency Medicine, Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia, USA
- Children's Healthcare of Atlanta, Atlanta, Georgia, USA
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19
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Teherani MF, Kao CM, Camacho-Gonzalez A, Banskota S, Shane AL, Linam WM, Jaggi P. Burden of Illness in Households With Severe Acute Respiratory Syndrome Coronavirus 2-Infected Children. J Pediatric Infect Dis Soc 2020; 9:613-616. [PMID: 32780809 PMCID: PMC7454727 DOI: 10.1093/jpids/piaa097] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Accepted: 08/10/2020] [Indexed: 11/12/2022]
Abstract
We investigated of illness among household members of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)-infected children receiving medical care (n = 32). We identified 144 household contacts (HCs): 58 children and 86 adults. Forty-six percent of HCs developed symptoms consistent with coronavirus disease. Child-to-adult transmission was suspected in 7 cases.
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Affiliation(s)
- Mehgan F Teherani
- Department of Pediatrics, Emory University School of Medicine, Children’s healthcare of Atlanta, Atlanta, GA, USA
- Alternate corresponding authors: Mehgan Teherani, MD, MS. , Carol Kao, MD.
| | - Carol M Kao
- Department of Pediatrics, Washington University School of Medicine in St. Louis, St. Louis, MO, USA
- Alternate corresponding authors: Mehgan Teherani, MD, MS. , Carol Kao, MD.
| | - Andres Camacho-Gonzalez
- Department of Pediatrics, Emory University School of Medicine, Children’s healthcare of Atlanta, Atlanta, GA, USA
| | | | - Andi L Shane
- Department of Pediatrics, Emory University School of Medicine, Children’s healthcare of Atlanta, Atlanta, GA, USA
| | - William M Linam
- Department of Pediatrics, Emory University School of Medicine, Children’s healthcare of Atlanta, Atlanta, GA, USA
| | - Preeti Jaggi
- Department of Pediatrics, Emory University School of Medicine, Children’s healthcare of Atlanta, Atlanta, GA, USA
- Corresponding Author: Preeti Jaggi, MD. 2015 Uppergate Drive NE, Atlanta, GA 30322. Phone: 404-727-4807. Fax: 404-727-9098.
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20
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Shah M, Murray A, Gillespie S, Camacho-Gonzalez A. 2525. Understanding PrEP in Female Adolescents: A Parent/Adolescent Dyad Perspective. Open Forum Infect Dis 2019. [PMCID: PMC6809784 DOI: 10.1093/ofid/ofz360.2203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background Adolescents aged 13–24 years account for 23% of HIV diagnoses in the Atlanta Metropolitan Area, indicating the need for new prevention strategies. Pre-Exposure Prophylaxis (PrEP), recently approved for adolescent use, is effective in HIV prevention and is often marketed to young men who have sex with men (MSM); however, problems with access, scalability and waning adherence have limited its use in this population and more broadly. A 2016 CDC HIV surveillance report showed 19.2% of new HIV diagnoses were attributed to heterosexual transmission in women aged 13–24, relative to 0% in their heterosexual male counterparts, and 5.4% in same-aged MSM. This study assesses parent and female adolescent knowledge on HIV risk and PrEP perception to inform potential implementation strategies. Methods PrEP acceptability and barrier surveys were administered to 102 adolescent-parent dyads attending an adolescent clinic and emergency room in Atlanta, Georgia. Eight female adolescent-parent pairs were randomly selected to participate in in-depth phone interviews. Responses were analyzed using computer-assisted thematic analyses. Results Of the 8 female adolescent participants (mean age = 18.9 years), all were African American, and 1 was sexually active. Of the 8 parent participants (mean age = 44.1 years), all were female and African American. None of the participants had ever used PrEP. Analysis indicated that both parents and adolescent females had poor HIV risk assessment and knowledge, as well as barriers to PrEP usage including concerns about side effects, cost, and desire for alternative PrEP delivery methods and/or schedules. Finally, adolescent females expressed reliance on self-efficacy to be able to discuss HIV protection methods with their partner. Conclusion Female adolescents use unreliable methods to ensure HIV prevention, and with poor HIV knowledge, are at risk of transmission. Thus, PrEP may be a viable option for adolescent females at high risk for infection. PrEP implementation strategies in adolescents needs to consider HIV risk assessment, PrEP education, potential options for alternative dosing and delivery, and continued implementation work, focused beyond just the young MSM community. Disclosures All authors: No reported disclosures.
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Affiliation(s)
- Meera Shah
- Emory University School of Medicine, Atlanta, Georgia
| | - Ashley Murray
- Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Scott Gillespie
- School of Medicine, Department of Pediatrics, Emory University, Atlanta, Georgia
| | - Andres Camacho-Gonzalez
- Ponce Family and Youth Clinic, Grady Infectious Diseases Program, Grady Health Systems, Atlanta, Georgia
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21
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Moore S, Jones M, Smith JC, Hood J, Harper GW, Camacho-Gonzalez A, Del Rio C, Hussen SA. Homonegativity Experienced over the Life Course by Young Black Gay, Bisexual and Other Men Who Have Sex with Men (YB-GBMSM) Living with HIV in Atlanta, Georgia. AIDS Behav 2019; 23:266-275. [PMID: 31463712 PMCID: PMC8380492 DOI: 10.1007/s10461-019-02658-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Minority stress theory posits that homonegativity-whether experienced, anticipated, or internalized-adversely impacts health. We conducted qualitative interviews with 28 YB-GBMSM living with HIV to explore manifestations of homonegativity over the life course. Thematic analysis identified patterns in the ways that homonegativity was discussed at different points in participants' lives. Stifling, and sometimes traumatic, familial and religious environments led to experienced homonegativity early in life. These experiences led to anticipated and internalized homonegativity, which in turn shaped sexual identity formation processes in adolescence and into young adulthood. Ultimately, many participants distanced themselves from home environments, seeking and often finding extrafamilial support. Most participants eventually reached self-acceptance of both their sexuality and HIV status. In conclusion, experienced, anticipated and internalized homonegativity were pervasive as YB-GBMSM navigated family and religious environments over the life course. Future interventions should work with youth, families, and churches to prevent these harmful experiences.
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Affiliation(s)
- Shamia Moore
- Hubert Department of Global Health, Emory University Rollins School of Public Health, Atlanta, Georgia
| | - Marxavian Jones
- Hubert Department of Global Health, Emory University Rollins School of Public Health, Atlanta, Georgia
| | - Justin C Smith
- Department of Behavioral Sciences and Health Education, Emory University Rollins School of Public Health, Atlanta, Georgia
| | - Jasper Hood
- Hubert Department of Global Health, Emory University Rollins School of Public Health, Atlanta, Georgia
| | - Gary W Harper
- Department of Health Behavior and Health Education, University of Michigan School of Public Health, Ann Arbor, MI, USA
| | - Andres Camacho-Gonzalez
- Division of Infectious Diseases, Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia
| | - Carlos Del Rio
- Hubert Department of Global Health, Emory University Rollins School of Public Health, Atlanta, Georgia
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia
| | - Sophia A Hussen
- Hubert Department of Global Health, Emory University Rollins School of Public Health, Atlanta, Georgia.
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia.
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22
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Hackett S, Badell ML, Meade CM, Davis JM, Blue J, Curtin L, Camacho-Gonzalez A, Chahroudi A, Chakraborty R, Nguyen MLT, Palmore MP, Sheth AN. Improved Perinatal and Postpartum Human Immunodeficiency Virus Outcomes After Use of a Perinatal Care Coordination Team. Open Forum Infect Dis 2019; 6:ofz183. [PMID: 31198816 PMCID: PMC6545466 DOI: 10.1093/ofid/ofz183] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2019] [Accepted: 04/08/2019] [Indexed: 11/14/2022] Open
Abstract
In a high-volume clinic in the Southeastern United States, pregnant women living with human immunodeficiency virus (HIV) had improved HIV outcomes up to 6 months after delivery following the introduction of a multidisciplinary perinatal care coordination team.
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Affiliation(s)
| | - Martina L Badell
- Infectious Diseases Program, Grady Health System, Atlanta, Georgia.,Department of Gynecology and Obstetrics, Division of Maternal-Fetal Medicine, Atlanta, Georgia
| | | | | | - Jeronia Blue
- Infectious Diseases Program, Grady Health System, Atlanta, Georgia
| | - Lisa Curtin
- Infectious Diseases Program, Grady Health System, Atlanta, Georgia
| | - Andres Camacho-Gonzalez
- Infectious Diseases Program, Grady Health System, Atlanta, Georgia.,Department of Pediatrics, Division of Infectious Diseases, Atlanta, Georgia
| | - Ann Chahroudi
- Infectious Diseases Program, Grady Health System, Atlanta, Georgia.,Department of Pediatrics, Division of Infectious Diseases, Atlanta, Georgia
| | - Rana Chakraborty
- Infectious Diseases Program, Grady Health System, Atlanta, Georgia.,Department of Pediatrics, Division of Infectious Diseases, Atlanta, Georgia
| | - Minh Ly T Nguyen
- Infectious Diseases Program, Grady Health System, Atlanta, Georgia.,Department of Medicine, Division of Infectious Diseases, Atlanta, Georgia
| | - Melody P Palmore
- Infectious Diseases Program, Grady Health System, Atlanta, Georgia.,Department of Medicine, Division of Infectious Diseases, Atlanta, Georgia
| | - Anandi N Sheth
- Infectious Diseases Program, Grady Health System, Atlanta, Georgia.,Department of Medicine, Division of Infectious Diseases, Atlanta, Georgia
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23
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Hussen SA, Jones M, Moore S, Hood J, Smith JC, Camacho-Gonzalez A, Del Rio C, Harper GW. Brothers Building Brothers by Breaking Barriers: development of a resilience-building social capital intervention for young black gay and bisexual men living with HIV. AIDS Care 2019; 30:51-58. [PMID: 30626207 DOI: 10.1080/09540121.2018.1527007] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Young Black gay/bisexual and other men who have sex with men (YB-GBMSM) are disproportionately impacted by HIV/AIDS. Novel intervention strategies are needed to optimize engagement in HIV care for this population. We sought to develop a group-level intervention to enhance resilience by augmenting social capital (defined as the sum of resources in an individual's social network) among YB-GBMSM living with HIV, with the ultimate goal of improving engagement in HIV care. Our multiphase, community-based participatory research (CBPR) intervention development process included: (1) Development and maintenance of a youth advisory board (YAB) comprised of YB-GBMSM living with HIV; (2) Qualitative in-depth interviews with YB-GBMSM living with HIV; (3) Qualitative in-depth interviews with care and service providers at clinics and community-based organizations; and (4) Collaborative development of intervention modules and activities with our YAB, informed by social capital theory and our formative research results. The result of this process is Brothers Building Brothers By Breaking Barriers, a two-day, 10-module group-level intervention. The intervention does not focus exclusively on HIV, but rather takes a holistic approach to supporting youth and enhancing resilience. Intervention modules aim to develop resilience at the individual level (exploration of black gay identity, development of critical self-reflection and coping skills), social network level (exploring strategies for navigating family and intimate relationships) and community level (developing strategies for navigating clinical spaces and plans for community participation). Most intervention activities are interactive, in order to facilitate new social network connections - and accompanying social capital - within intervention groups. In summary, our intensive CBPR approach resulted in a novel, culturally-specific intervention designed to enhance HIV care engagement by augmenting resilience and social capital among YB-GBMSM living with HIV.
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Affiliation(s)
- Sophia A Hussen
- a Hubert Department of Global Health , Emory University Rollins School of Public Health , Atlanta , GA , USA
| | - Marxavian Jones
- a Hubert Department of Global Health , Emory University Rollins School of Public Health , Atlanta , GA , USA
| | - Shamia Moore
- a Hubert Department of Global Health , Emory University Rollins School of Public Health , Atlanta , GA , USA
| | - Jasper Hood
- a Hubert Department of Global Health , Emory University Rollins School of Public Health , Atlanta , GA , USA
| | - Justin C Smith
- b Department of Behavioral Science and Health Education , Emory University Rollins School of Public Health , Atlanta , GA , USA
| | - Andres Camacho-Gonzalez
- c Department of Pediatrics, Division of Infectious Diseases , Emory University School of Medicine , Atlanta , GA , USA
| | - Carlos Del Rio
- a Hubert Department of Global Health , Emory University Rollins School of Public Health , Atlanta , GA , USA
| | - Gary W Harper
- d Department of Health Behavioral and Health Education , University of Michigan School of Public Health , Ann Arbor , MI , USA
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24
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Hussen SA, Chakraborty R, Camacho-Gonzalez A, Njiemoun B, Grossniklaus E, Goodstein E, Stephenson R, del Rio C. Beyond "purposeful and planned": varied trajectories of healthcare transition from pediatric to adult-oriented care among youth living with HIV. AIDS Care 2019; 31:45-47. [PMID: 29897258 PMCID: PMC9976190 DOI: 10.1080/09540121.2018.1488029] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
Healthcare transition (HCT) from pediatric to adult-oriented healthcare is ideally conceptualized as a planned, continuous process characterized by communication between multiple stakeholders. However, empirical data is lacking regarding processes through which youth living with HIV (YLHIV) are actually transitioned to adult care. We conducted a qualitative study to gain a more comprehensive understanding of both pediatric and adult provider perspectives on the HCT process for YLHIV. Our study included focus groups discussions with 24 (11 pediatric and 13 adult) providers at a comprehensive HIV care center in the Southeastern United States. Providers described YLHIV and their HCT trajectories as diverse and complex. They described three distinct HCT trajectories: the Ideal Transition, the Abrupt Transition, and the De Facto Transition. Providers agreed that the most important determinant of successful engagement in adult-oriented care (post-HCT) appeared to be consistent prior engagement while in pediatric care (pre-HCT). In summary, risk for disengagement is not uniform among YLHIV transitioning to adult care, and HCT does not always occur in a seamless or linear fashion. Our data suggest that interventions aiming to improve HCT should be more tailored, focusing intensified efforts on those YLHIV with difficulty maintaining consistent engagement in pediatric care.
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Affiliation(s)
- Sophia A. Hussen
- Hubert Department of Global Health, Emory University Rollins School of Public Health, 1518 Clifton Rd NE, Atlanta, GA 30322, USA,Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, 49 Jesse Hill Jr. Drive, Atlanta, GA 30303, USA
| | - Rana Chakraborty
- Division of Infectious Diseases, Department of Pediatrics, Emory University School of Medicine, 2015 Uppergate Drive Suite 500, Atlanta, GA 30322, USA
| | - Andres Camacho-Gonzalez
- Division of Infectious Diseases, Department of Pediatrics, Emory University School of Medicine, 2015 Uppergate Drive Suite 500, Atlanta, GA 30322, USA
| | - Berthine Njiemoun
- Hubert Department of Global Health, Emory University Rollins School of Public Health, 1518 Clifton Rd NE, Atlanta, GA 30322, USA
| | - Emily Grossniklaus
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, 49 Jesse Hill Jr. Drive, Atlanta, GA 30303, USA
| | - Emma Goodstein
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, 49 Jesse Hill Jr. Drive, Atlanta, GA 30303, USA
| | - Rob Stephenson
- Department of Health Behavior and Biological Sciences, University of Michigan School of Nursing, 400 North Ingalls Building, Ann Arbor, MI 48109, USA
| | - Carlos del Rio
- Hubert Department of Global Health, Emory University Rollins School of Public Health, 1518 Clifton Rd NE, Atlanta, GA 30322, USA,Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, 49 Jesse Hill Jr. Drive, Atlanta, GA 30303, USA
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25
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Joo SJ, Grimsley-Ackerley C, Camacho-Gonzalez A, Jaggi P, Gonzalez M. 2312. Bordetella holmesii Bacteremia in Pediatric Patients: A Single-Center Experience. Open Forum Infect Dis 2018. [PMCID: PMC6254042 DOI: 10.1093/ofid/ofy210.1965] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background Methods Results Conclusion Disclosures
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Affiliation(s)
- Su Jin Joo
- Division of Pediatric Infectious Diseases, Emory University School of Medicine, Atlanta, Georgia
| | - Cassie Grimsley-Ackerley
- Division of Pediatric Infectious Diseases, Emory University School of Medicine, Atlanta, Georgia
| | - Andres Camacho-Gonzalez
- Division of Pediatric Infectious Diseases, Emory University School of Medicine, Atlanta, Georgia
| | - Preeti Jaggi
- Division of Pediatric Infectious Diseases, Emory University School of Medicine, Atlanta, Georgia
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26
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Thompson A, Gillespie SE, Hood J, Seaton L, Camacho-Gonzalez A. The Impact of Illicit Drug Use on Viral Suppression and Retention in Care among HIV-Positive Adolescents and Young Adults. Open Forum Infect Dis 2016. [DOI: 10.1093/ofid/ofw172.1246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Amelia Thompson
- Department of Pediatrics, Division of Pediatric Infectious Diseases, Emory University School of Medicine, Atlanta, GA
| | - Scott E. Gillespie
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA
| | - Jasper Hood
- Ponce Family and Youth Clinic, Grady Infectious Diseases Program, Grady Health Systems, Atlanta, GA
| | - Lateshia Seaton
- Ponce Family and Youth Clinic, Grady Infectious Diseases Program, Grady Health Systems, Atlanta, GA
| | - Andres Camacho-Gonzalez
- Department of Pediatrics, Division of Pediatric Infectious Diseases, Emory University School of Medicine, Atlanta, GA
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27
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Shah M, Holt S, Morris CR, Gillespie SE, Camacho-Gonzalez A. Acceptability and Barriers to Pre-exposure Prophylaxis (PrEP) in Atlanta's Adolescents and Their Parents. Open Forum Infect Dis 2016. [DOI: 10.1093/ofid/ofw172.1242] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Meera Shah
- Emory University School of Medicine, Atlanta, GA
| | - Stephanie Holt
- Department of Pediatrics, Division of Adolescent Medicine, Emory University, Atlanta, GA
| | - Claudia R. Morris
- Department of Pediatrics, Division of Emergency Medicine, Emory University, Atlanta, GA
| | - Scott E. Gillespie
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA
| | - Andres Camacho-Gonzalez
- Department of Pediatrics, Division of Pediatric Infectious Diseases, Emory University School of Medicine, Atlanta, GA
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28
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Abstract
Neonatal sepsis remains a feared cause of morbidity and mortality in the neonatal period. Maternal, neonatal, and environmental factors are associated with risk of infection, and a combination of prevention strategies, judicious neonatal evaluation, and early initiation of therapy are required to prevent adverse outcomes. This article reviews recent trends in epidemiology and provides an update on risk factors, diagnostic methods, and management of neonatal sepsis.
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Affiliation(s)
- Andres Camacho-Gonzalez
- Division of Pediatric Infectious Diseases, Emory Department of Pediatrics, Children's Healthcare of Atlanta, Emory University, Atlanta, GA 30322, USA.
| | - Paul W. Spearman
- Nahmias-Schinazi Professor and Chief, Pediatric Infectious Diseases, Vice Chair for Research, Emory Department of Pediatrics, Emory University, Chief Research Officer, Children’s Healthcare of Atlanta, Georgia, 2015 Uppergate Drive, Suite 500, Atlanta, GA 30322, P:404-727-5642, F:404-727-9223
| | - Barbara J. Stoll
- George W. Brumley, Jr. Professor and Chair of the Department of Pediatrics, Medical Director of Children’s Healthcare of Atlanta at Egleston, President of the Emory-Children’s Center, 2015 Uppergate Drive, Suite 200, Atlanta, GA 30322
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29
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Abstract
HIV-infected adolescents represent a unique, yet diverse, population requiring specialized medical and psychosocial HIV care. Perinatally infected and behaviorally infected adolescents often have differing therapeutic needs, but may share common difficulties, including medication nonadherence, high-risk sexual behavior, psychosocial stressors, and concomitant psychiatric disorders. Addressing these needs within a culturally sensitive framework and in the context of a population-specific approach to treatment is paramount to optimizing care. Harm reduction for this group to maximize their health and limit HIV transmission to others is also critical with respect to the rising incidence of newly diagnosed HIV-positive adolescents. Implementing a formal, multidisciplinary program that involves individual youths and their families for improved transition to adult HIV care will afford such adolescents a better chance for a healthy adulthood.
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Affiliation(s)
- Allison C Ross
- Pediatric Infectious Diseases, Emory University School of Medicine, 2015 Uppergate Drive, NE, Atlanta, GA, 30322, USA,
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